Provider Demographics
NPI:1972863397
Name:SMILES IN MOTION, S.C.
Entity Type:Organization
Organization Name:SMILES IN MOTION, S.C.
Other - Org Name:SMILES IN MOTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GOODLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-723-2000
Mailing Address - Street 1:583 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:583 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1689
Practice Address - Country:US
Practice Address - Phone:715-723-2000
Practice Address - Fax:715-723-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5855-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33796700Medicaid